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Application form

Please retur n to:


please attach a recent
please attach a second
(Centre stamp) passport-sized
identical signed
photograph here securely
passpor t-sized
(Note: the photograph
photograph here using a
must not be more
paper clip
than 6 months old)

PLEASE WRITE IN BLOCK


CAPITALS
ddmmyy
11 Preferred date of test second choice
d
22 Family name m 33 Title
(Dr/Mr/Mrs/Miss/Ms)
m

y
44 Other name(s) y
(these names must be the same as the names on your passpor t/National Identity Card
and must appear in the same order.)

55 Address: please note you will only be sent one copy of your results. Please ensure the correct mailing address is
given, since your results will be sent to this address.

66 Telephone/Mobile number

77 email

ddmmyy
88 Date of bir th 99 Gender FM (circle as
appropriate)

10 Please indicate which document you will be using as proof of identity and give the number below.
10
Candidates taking the test outside their own countr y must present a current passport or National Identity Card. You
must bring the ID document indicated below to the test. This is the only for m of identity that will be accepted on the
test day. The document must be valid/not expired at registration and on the test day.

Passport National Identity Card

Passport or National Identity Card number

For office use only

ddmmyy
scheme test date

date of payment receiptd number


dmmyy

ID checked Administrator’s initials

1
For questions 11–14 please enter codes and the name of the country and first language.
Codes can be found on pages ii–iv. Please take care and enter this information accurately.
If the codes you enter here are incorrect, the infor mation on your Test Repor t Form will also be incorrect.

11 Country or region of origin (code) 12


12 First language (code)
11
First language (name)

Country or region of origin (name)

13
13 Occupation (sector) if other, please specify

Occupation (level) if other, please specify

14 Why are you taking the test? if other, please specify

15
15 Which countr y are you applying/intending to go to? (tick one box only)

Australia Canada New Zealand Republic of Ireland United Kingdom

United States of America other, please specify

16
16 Which IELTS test format are you taking? (tick one box only) Academic General Training
Please note that it is the candidate’s responsibility to select the test format that best meets their
needs.
The General Training module is not available on every test
date.

17 Which IELTS test are you taking? pen and paper test computerised test (CB IELTS)
17 (tick one box only) (please check availability with the centre you are applying
to)

If you are taking CB IELTS are you taking the Writing Test on paper? (tick one box only) yes no

18 Have you taken IELTS (either Academic or General Training) before? yes no
(go to question 19) (go to question 20)

19 Most recent IELTS test details: Centre name


ddmmyy
Centre number date

20 Where are you currently studying English (if applicable)?


20

21 What level of education have you completed?


21 (tick one box only)

secondary up to 16 years secondary 16–19 years degree or equivalent post-graduate

22 How many years have you been studying English?


22 (tick one box only)

1 (less than)23456789 or more

23 Do you have any special needs due to ill health/medical conditions? yes no
23

If yes, please specify your requirements below. You must attach supporting medical evidence to this form.

Requests must be submitted at least 3 months before the test.

2
Institution Applications

24 Please give details below of academic institutions/government agencies/professional bodies/employers you would
24
like your results sent to. Add your file/case number if known. Results may be sent either electronically or by post to

these institutions. The centre may charge a postal fee for results sent internationally or by courier.

a) Name of person/department

Name of institution/agency/body/employer

File/case number

Address

b) Name of person/department

Name of institution/agency/body/employer

File/case number

Address

c) Name of person/department

Name of institution/agency/body/employer

File/case number

Address

d) Name of person/department

Name of institution/agency/body/employer

File/case number

Address

e) Name of person/department

Name of institution/agency/body/employer

File/case number

Address

3
Your rights
Information we hold on you is very broad and could include information we do not make available. If you wish to view a copy of your
personal details contained in the Application Form contact ielts@ucles.org.uk. A charge of £10 will be made for access to this
information. You also have the right to have inaccuracies in your personal details corrected. Please contact us if you find that your
information is inaccurate. Documentation must be provided to verify the correct details.

Declaration
• I certify that the information on this form is complete, true and accurate. I understand that if any other person attempts to take
the IELTS examination in my place (i.e. in place of the person whose details appear on this form), both I and such person will be
liable to prosecution.

• I understand that I will be charged the full test fee if I postpone or cancel my test within 5 weeks of the test date, unless I provide
appropriate medical evidence to support the postponement or cancellation. Only evidence of serious illness will be considered.
I understand that medical evidence must be provided within 5 days of the test date.

• I understand that if I attempt to cheat, copy the work of another candidate, disrupt the test, remove or copy or attempt to remove
or copy any test materials from the examination room or do anything that might damage the integrity and security of IELTS, I will
not receive a result for the test, my test fee will not be refunded and I may be prohibited from taking IELTS tests in future.

• I acknowledge receipt of the document entitled ‘ IELTS Information for candidates ’.

• I acknowledge receipt of the Notice to IELTS Candidates document, contained on page i of this document and under take to abide
by the regulations contained within.

• I agree an observer may attend my Speaking Test as part of the monitoring process.

• I agree that a photograph may be taken of me on the test day to confirm identity.

• I acknowledge that the IELTS examination is administered by British Council, IDP:IELTS Australia, and Cambridge ESOL collectively
referred to as the test par tners, and I understand and agree that the details on this form are collected for the purposes of the IELTS
test and that these details may be disclosed to, processed and stored by the test partners for the purpose of such administration
and that these details and my examination results may be disclosed by the test partners to those academic institutions or other
entities to whom I submit my enrolment application, for the purpose of allowing such institutions or entities to verify the results of
the test or to car ry out an investigation in relation to suspected fraud. If the test partners discover that a false or altered Test Report
Form has been provided to any of these institutions or entities the test partners may inform the same and provide them with my
personal details.

• I understand that my results may not be issued within 13 days of the test day if any of the test partners deem it necessary to
review any matter associated with my test. I understand that in exceptional circumstances I may be required to re-take one or more
IELTS modules.

• I understand that my personal data may be processed in an anonymous form for statistical and research purposes for the
development of Cambridge ESOL examinations. Cambridge ESOL and the centre administering the test confirm that they will not
disclose personal information about candidates to others except as stated in this Declaration or to the extent permitted by law.

• I understand that the work I produce as par t of the IELTS test remains the property of the test partners and under no
circumstances will be released to candidates or institutions/organisations.

• I understand that if the details on this form are not completed my application may not be processed.

Disclaimer: The International English Language Testing System (IELTS) is designed to be but one of many factors used by academic
institutions, government agencies, professional bodies and employers in determining whether a test taker has sufficient English skills
to successfully be admitted as a student or be considered for employment. IELTS is specifically designed not to be the sole method of
determining admission or employment for the test taker. IELTS is made available worldwide to all persons, regardless of age, gender,
race, nationality or religion but it is not recommended to persons under 16 years of age.

British Council, IDP:IELTS Australia and Cambridge ESOL and any other party involved in creating, producing, or delivering IELTS shall
not be liable for any direct, incidental, consequential, indirect, special, punitive, or similar damages arising out of access to, use of,
acceptance by, or interpretation of the results by any third party, or any errors or omissions in the content thereof.

ddmmyy
Signature Date

E M C/ 311 0B/ 6Y 07 © UCL ES 20 06


4
This notice has been written to help you.
Read it carefully and do as you are

Notice to IELTS Candidates asked. If there is anything you do not


understand, ask the IELTS Administrator
or the examination supervisor.

Disqualification warning
If you are caught infringing any of the candidate rules and regulations your test result will
be disqualified and notification sent to any receiving institution or professional body.

Rules and Regulations


Y u mu s t … u mu s t no t …
o • Provide proof of your identity (e.g. passport or national • Impersonate another person or have another person
identity card) at registration and every examination session. impersonate you.
Second country nationals must produce a passport. This ID • Attempt to cheat, copy the work of another candidate or
must contain a number, a signature, a date of birth and a disrupt the test.
photograph.
• Use, or attempt to use, a dictionary, pager, spell-checker,
• Provide two recent identical passport-sized photographs electronic recorder or mobile phone for the duration of the
on registration. test. Any candidate doing so will be disqualified.
• Only have on your desk your identification, a pen/pencil and • Talk to or disturb other candidates once the examination
an eraser. has started.
• Ensure mobile phones, pagers and any other electronic • Smoke, eat or drink in the examination room.
devices are switched off and placed with personal
• Reproduce any part of the test in any format/medium.
belongings outside the test room.
Any candidate doing so will have their test results
Any candidate who does not switch off their phone/pager,
disqualified and be liable to prosecution.
or who retains one in their possession, will be disqualified.
• Remove any materials used during the examination.
• Notify the test invigilator immediately if test day conditions in
This includes, but is not limited to, examination papers,
any way impede your performance.
speaking task cards, answer papers and working paper.

Advice and infor mation • Read carefully and follow the instructions printed on the
question paper and on the answer sheet.
Make sure you attend on time • Fill in the details required on the front of your question
• Know the date, time and place of your examination and paper and on your answer sheet before the start of the
arrive before the scheduled starting time. examination.
• If you ar rive late for any of the papers, report to the
supervisor or invigilator. You may not be allowed to take Advice and assistance during the examination
the examination. • If you are in doubt about what you should do, raise your
hand to attract attention. An invigilator will come to your
Provide what you need assistance.
• Take into the examination room only the pens, pencils and • You may not ask for, and will not be given, any explanation
erasers which you need for the examination. of the questions.
• Correction fluid and highlighters must not be used. • If on the day of the examination you feel that your work may
• Leave anything which you do not need, or which is not be affected by ill health or any other reason, you must inform
allowed, outside the examination room. the invigilator at the time.
• You may not lend anything to, or borrow anything from,
Leaving the examination room
another candidate during the examination.
• You may not leave the examination room without the
• Do not bring valuables as the test centre cannot be permission of the supervisor or invigilator.
responsible for these.
• You can not leave your seat until all papers have been
Examination instructions collected and you have been told you can leave.
• Listen to the supervisor and do what you are asked to do. • When you leave the examination room you must leave behind
• Tell the supervisor or invigilator at once any paper used for rough work clearly crossed through and
– if you think you have not been given the right any other materials provided for the examination.
question paper. • Do not make any noise near the examination room.
– if the question paper is incomplete or illegible.

Results • In exceptional circumstances, results may be delayed and


you may be required to re-take one or more modules where
• Results are issued by test centres, usually 13 days after the pattern of module results is highly unusual.
the test. • Please note that institutions and organisations you have listed
• Results may be delayed or withheld where any of the Rules under question 24 may access your results before you have
and Regulations have been breached. received them by mail.

i
Important: please read this section (i-iv) and retain for your own records.
Codes to enter for questions 11–14
Refer to the lists below for the codes to enter for your country or region of origin, your first language and
your occupation.
If either your first language or your country or region of origin is not listed, enter '000'. Look for the closest
description of your occupation and proposed area of study. If your work or position is not covered at all,
then enter '00'.

Question 11 – Country or region of origin


Afghanistan 001 France 066 Monaco 129
Albania 002 French Guinea 067 Mongolia 130
Algeria 003 French Polynesia 068 Montenegro 131
America Samoa 004 Gabon 069 Montserrat 132
Andorra 005 Gambia 070 Morocco 133
Angola 006 Georgia (Republic of) 071 Mozambique 134
Antigua and Barbuda 007 Germany 072 Myanmar 135
Argentina 008 Ghana 073 Namibia 136
Armenia (Republic of) 009 Gibraltar 074 Nauru 137
Aruba 223 Greece 075 Nepal 138
Australia 010 Greenland 076 Netherlands 139
Austria 011 Grenada 077 Netherlands Antilles 140
Azerbaijan 012 Guadaloupe 078 New Caledonia 141
Bahamas 013 Guam 079 New Zealand 142
Bahrain 014 Guatemala 080 Nicaragua 143
Bangladesh 015 Guinea 081 Niger 144
Barbados 016 Guinea-Bissau 082 Nigeria 145
Belarus (Republic of) 017 Guyana 083 Niue (Cook Island) 146
Belgium 018 Haiti 084 Norfolk Island 229
Belize 019 Holy See 212 Northern Mariona Islands 230
Benin 020 Honduras 085 Norway 147
Bermuda 021 Hong Kong 086 Oman 148
Bhutan 022 Hungary 087 Pakistan 149
Bolivia 023 Iceland 088 Palau 231
Bosnia-Herzegovina 024 India 089 Palestine 150
Botswana 025 Indonesia 090 Panama 151
Brazil 026 Iran 091 Papua New Guinea 152
Brunei, Darussalem 027 Iraq 092 Paraguay 153
Bulgaria 028 Ireland 093 Peru 154
Burkina Faso 029 Israel 094 Philippines 155
Burundi 031 Italy 095 Pitcairn Island 156
Cambodia 032 Jamaica 097 Poland 157
Cameroon 033 Japan 098 Portugal 158
Canada 034 Jordan 099 Puerto Rico 159
Canton and Enderburys Phoenix Is 035 Kazakhstan 100 Qatar 160
Cape Verde 036 Kenya 101 Reunion 161
Caroline Islands 037 Kiribati 102 Romania 162
Cayman Islands 038 Korea, North 103 Russia 163
Central African Republic 039 Korea, South 104 Rwanda 164
Chad 040 Kuwait 105 San Marino 165
Chile 041 Kyrgystan 226 Sao Tome and Principe 166
China (People's Republic of) 042 Laos 106 Saudi Arabia 167
Colombia 043 Latvia (Republic of) 107 Senegal 168
Comoros 044 Lebanon 108 Serbia 169
Congo 045 Lesotho 109 Seychelles 170
Cook Islands 046 Liberia 110 Sierra Leone 171
Costa Rica 047 Libya 111 Singapore 172
Côte d’Ivoire 096 Liechtenstein 112 Slovakia (Republic of) 173
Croatia (Republic of) 048 Lithuania (Republic of) 113 Slovenia (Republic of) 174
Cuba 049 Luxembourg 114 Solomon Islands 175
Cyprus 050 Macao 115 Somalia 176
Czech Republic 051 fyr Macedonia 225 South Africa 177
Denmark 052 Madagascar 116 Spain 178
Djibouti 053 Malawi 117 Sri Lanka 179
Dominica 054 Malaysia 118 St. Helena 180
Dominican Republic 055 Maldives 119 St. Kitts-Nevis-Anguilla 181
Ecuador 056 Mali 120 St. Lucia 182
Egypt 057 Malta 121 St. Pierre and Miquelon 183
El Salvador 058 Marshall Islands 122 St. Vincent and the Grenadines 184
Equatorial Guinea 059 Martinique 123 Sudan 185
Eritrea 060 Mauritania 124 Surinam 186
Estonia 061 Mauritius 125 Svalbard and Jan Mayen Islands 232
Ethiopia 062 Mayotte 227 Swaziland 187
Faeroe Islands 063 Mexico 126 Sweden 188
Falkland Islands 224 Micronesia (Federal States of) 228 Switzerland 189
Fiji 064 Midway Islands 127 Syria 190
Finland 065 Moldova (Republic of) 128 Tahiti 191

ii
Question 12 – First Language
Taiwan 192 Afrikaans 001 Marshallese 077
Tajikistan 233 Akan 002 Masai 078
Tanzania 193 Albanian 003 Mende 079
Thailand 194 Amharic 004 Mongolian 080
Timor-Leste 222 Arabic 005 Nepali 081
Togo 195 Armenian 006 Norwegian 082
Tokelau 196 Assamese 007 Oriya 083
Tonga 197 Aymara 008 Palauan 084
Trinidad and Tobago 198 Azeri 009 Punjabi 085
Tunisia 199 Baluchi 010 Pashto 086
Turkey 200 Bambara 011 Polish 087
Turkmenistan 234 Basque 012 Ponapean 088
Turks and Caicos Islands 201 Bemba 013 Portuguese 089
Tuvalu 202 Bengali 014 Pushtu 090
Uganda 203 Bihari 015 Quechua 091
Ukraine 204 Bosnian 901 Rajasthani 092
United Arab Emirates 205 Breton 016 Rif f 093
United Kingdom 206 Bulgarian 017 Romanian 094
Uruguay 207 Burmese 018 Romansch 095
US Virgin Islands 208 Byelorussian 019 Russian 096
United States of America 209 Catalan 020 Samoan 097
Uzbekistan (Republic of) 210 Chinese 021 Serbian 098
Vanuatu 211 Creole 022 Setswana 099
Venezuela 213 Croatian 023 Shona 100
Vietnam 214 Czech 024 Sindhi 101
Wallis and Futuna Islands 215 Danish 025 Singhalese 102
Western Sahara 216 Dari 026 Slovak 103
Western Samoa 217 Dzongkha 027 Slovene 104
Yemen (Republic of) 218 Dutch 028 Somali 105
Zaire 219 Efik 029 Spanish 106
Zambia 220 English 030 Swahili 107
Zimbabwe 221 Estonian 031 Swazi 108
Other 000 Ewe 032 Swedish 109
Faeroese 033 Tagalog 110
Farsi 034 Tahitian 111
Fijian 035 Tamil 112
Finnish 036 Tatar 113
Flemish 037 Telugu 114
French 038 Tetum 136
Fulani 039 Thai 115
Ga 040 Tibetan 116
Georgian 041 Tigrinya 117
German 042 Tongan 118
Gilbertese 043 Trukese 119
Greek 044 Tulu 120
Gujarati 045 Tupi/Guarani 121
Haitian Creole 046 Turkish 122
Hausa 047 Uighur 123
Hebrew 048 Ukrainian 124
Hindi 049 Ulithian 125
Hungarian 050 Urdu 126
Ibo/lgbo 051 Uzbek 127
Icelandic 052 Vietnamese 128
Igala 053 Wolof 129
Indonesian 054 Xhosa 130
Italian 055 Yao 131
Japanese 056 Yapese 132
Javanese 057 Yiddish 133
Kannada 058 Yoruba 134
Kashmiri 059 Zulu 135
Kazakh 060 Other 000
Khmer 061
Korean 062
Kurdish 063
Lao 064
Latvian 065
Lithuanian 066
Luba 067
Luo 068
Luxemburgish 069
Malagasy 070
Malay 071
Malayalam 072
Malinka 073
Maltese 074
Maori 075
Marathi 076

iii
Question 13 – Occupation

Example
If you are a student enter 08 because the Sector is
Education and 7 because the Level is Student.

0 8 7

Sector
Administrative services 01
Agriculture, Fishing, Forestry, Mining 02
Arts and Entertainment 03
Banking and Finance 04
Catering and Leisure 05
Construction Industries 06
Craft and Design 07
Education 08
Health and Social Services 09
Installation, Maintenance and Repair Services
10
Law and Legal Services 11
Manufacturing and Assembly Industries 12
Personal Services 13
Retail Trade
14
Technical and Scientific
15
Telecommunications and the Media
16
Transport 17
Utilities (gas, water etc) 18
Wholesale Trade 19
Other 00

Level
Self-employed 1
Employer/Partner 2
Employee (Senior level) 3
Employee (Middle or Junior level) 4
Worker in the home 5
Retired 6
Student 7
Other 0

Question 14 – Why you are taking this test? Checklist


For higher education extended course 1 I have signed the Application Form.
(three months or more)
For higher education short course 2
(three months or less)
For other education purposes 3 I have provided 2 recent passport photographs
For registration as a doctor 4
(signed on the back).
For immigration 5
For employment 6
For professional registration (NOT medical) 7
For personal reasons 8 I have provided all the information required.
For registration as a nurse (including CGFNS) 9
For registration as a dentist 10
Other 0
I have enclosed the test fee.
(Please note that your application will not be
processed without this.)

iv
Important: please read this section (i-iv) and retain for your own records.